Sixty-seven-year-old Jack, diagnosed with dementia, was referred by his GP to the Bury Speech and Language Therapist (SLT) for a swallowing assessment after family members described Jack's struggles to chew foods that have texture, storing them in his cheeks, as well as sometimes coughing when eating and drinking.
Arranging a home visit so she could observe Jack in his own environment, the SLT notices he can engage in basic conversation but has difficulty understanding long sentences, a likely result of his impaired memory and communications skills.
Jack lives at home with his wife, his main carer, while family members visit daily – they use the living room for watching television, socialising and having meals.
But despite having a history of obesity, in the past 12 months Jack has become ‘picky’ with food – taking much longer to chew, spitting out lumps and finishing his meals or drinks – which has seen him lose weight to the point that he’s now at a normal level. But he’s still losing weight. Yet Jack’s family is proud of how they cook and encourage him to eat healthy meals including lots of vegetables and salads but they’re struggling to find food he enjoys and that he’ll finish.
SLT therapist observations finds that Jack:
- Sits in his armchair in a busy living room for meals and drinks – it’s a noisy space, with lots of talking and the television on in the background
- Self feeds but has some difficulty using a knife and fork – he needs to concentrate more to coordinate his hand to his mouth.
- Chews both bread and salad for a long time, intermittently spitting out – he usually eats around a quarter to half his meal.
- Takes so long to drink his cup of tea that its cold before he’s finished.
Jack has normal mouth motor muscles, well-fitting dentures and a normal swallow function. It’s therefore likely that his eating and drinking difficulties stem from a psychological or behavioural cause rather than physical such as Jack:
- Finding physically coordinating the task of eating and drinking has become more difficult
- May sometimes forget how to eat or drink
- Getting easily distracted which stops him from eating and/or drinking
- Not always recognising his feelings of hunger or thirst
- Finding it difficult to chew and swallow textured foods, a common problem for people with dementia.
After spending time educating Jack’s family on the eating and drinking difficulties of those with dementia and the consequences of him becoming malnourished and dehyrdrated, SLT advice included information leaflets, booklets and links to Age UK for the family so that they could read these and refer back to them when needed.
The SLT also advised on swallowing to improve Jacks quality of life and reduce his risk of being malnourished and rehyrdrated. These include:
- Reducing external distractions, turning TV off and aiming for a calm environment that’s focused only on eating and drinking
- Encouraging Jack into the kitchen so that he can see and smell food that’s being cooked or baked – even the morning coffee – which helps to stimulate saliva and appetite
- Show and tell Jack about his food and drink – ‘this is your favourite tomato soup with bread and butter’, ‘drink your tea while it is still warm’
- Avoid giving meals Jack struggles to eat, such as salad, tough meat or small lumps – aim for soft foods with finer texture
- Add extra calories where possible, experiment with different foods in case Jack’s tastes have changed and encourage nutritious snacks or drinks such as Horlicks or hot chocolate, especially if he doesn’t finish a meal
- Provide verbal and physical encouragement to keep Jack eating – place the cup or fork back in his hand and use gestures to support his understanding
- Encourage frequent drinks throughout the day, perhaps using squash rather than plain water – helps to keep urinary infections at bay, as these can be debilitating for people with dementia.
Two weeks later…
Jack’s family were surprised by how much seemingly small changes helped. They said Jack was not only eating and drinking more but also seemed to be enjoying food again.
With the family now aware of what’s needed and are committed to continuing with these changes, the SLT advised them how to re-refer Jack should his condition deteriorate again and if they needed new advice.
You’ll find the Age UK ‘Eating and Drinking Well Carers Guide’ here.
Find out more about the SLT service by calling the team on 0161 206 0576.